Improving public health care: lessons on governance from five cities

A tale of two obesCities: the role of municipal governance in reducing childhood obesity in New York City and London

As rates of childhood obesity and overweight rise around the world, researchers and policy makers seek new ways to reverse these trends. Given the concentration of the world's population, income inequalities, unhealthy diets, and patterns of physical activity in cities, urban areas bear a disproportionate burden of obesity. To address these issues, in 2008, researchers from the City University of New York and London Metropolitan University created the Municipal Responses to Childhood Obesity Collaborative. The Collaborative examined three questions: What role has city government played in responding to childhood obesity in each jurisdiction? How have municipal governance structures in each city influenced its capacity to respond effectively? How can policy and programmatic interventions to reduce childhood obesity also reduce the growing socioeconomic and racial/ethnic inequities in its prevalence? Based on a review of existing initiatives in London and New York City, the Collaborative recommended 11 broad strategies by which each city could reduce childhood obesity. These recommendations were selected because they can be enacted at the municipal level; will reduce socioeconomic and racial/ethnic inequalities in obesity; are either well supported by research or are already being implemented in one city, demonstrating their feasibility; build on existing city assets; and are both green and healthy.

Urban as a determinant of health

Cities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.